RECALL - HeAcHI initiative.

Vaccination is administration of agent-specific, but relatively harmless, antigenic components that in vaccinated individuals can induce protective immunity against the corresponding infectious agent. It is a cost-effective public health intervention, a proven tool in preventing and eradicating childhood infectious diseases - averting an estimated 4-5 million deaths each year. 

To achieve maximal protection from vaccine-preventable diseases, a child should receive all vaccines within recommended intervals. The World Health Organization estimates  that 29% of under five mortality could be prevented with existing vaccines. However, this is not always the case in many countries; for example, in Africa, approximately 1 in 5 children do not receive all the necessary and basic vaccines. As a result, more than thirty million children under-five suffer from vaccine-preventable diseases (VPDs) every year and over half a million of these children die from VPDs annually due to limited access to immunization services - accounting for 58% of all global
deaths. 

Uganda, a country where less than 50% of children are fully immunized typifies this problem. Its 2016 Demographic and Health Survey (DHS) report showed that only 49% of children aged 12 to 23 months received all recommended vaccinations by 12 months of age despite high coverage (95%) for the first dose of DTP. Vaccination coverage for the third dose of pentavalent vaccine (Penta3), which is given at 14 weeks of age, was found to be 79% with a Penta1-Penta3 dropout of 17%. In addition, the Uganda Health Management Information Systems (HMIS) estimates that only 55% of children aged 12–23 months were found to be fully vaccinated with coverage being relatively higher in urban areas (61%) than rural areas (50%). Full and timely dosage of these vaccines remains low, resulting in preventable disease outbreaks, threatening the health of children in Uganda. 

One study(Gavi, 2020) conducted in Kampala city in Uganda revealed that full immunization coverage was 41.4% and only 26.5% of the fully vaccinated children received all vaccines on time despite high access (96%) to immunization. There was a dropout rate from DPT1 to DPT3 of 17.3% presenting shrinkage in utilization over time.

According to needs assessment (base-line survey 2019) conducted in Bukedea Health Center 4, immunization dropout rates were still high at 26% as per the results from community diagnosis; this is higher than the national average  of 17% which is also higher than the national targeted dropout rate of 10% and way higher than the routine Expanded Program on immunization program dropout rate, where the dropout rate higher than 5% usually indicates quality problems. 

The survey partly attributes the high dropout rates to inability among caretakers to remember bringing their babies for vaccination as per planned dates, lack of knowledge about vaccine doses and lack of a follow up system for immunization to identify and trace defaulters. Reminding caretakers to bring their babies for shots and following them up has been shown to increase timely completion of vaccination rates.

Globally, there over 5.22 billion mobile phone users, representing 66% of the global population with an average yearly 3% increases in worldwide mobile phone penetration rates, and by the end of 2018, there were 456 million unique mobile subscribers in Sub-Saharan Africa, representing an increase of 20 million over the previous year. Our Solution leverages benefits in mobile technology to remind and followup child caretakers on child vaccination appointments using short message service (SMS).

Prompting health-seeking behavior via mobile technology interventions has been shown to improve health intervention uptake.

The solution we provide:

- increases vaccination recall rates for caregivers.

- increases collaboration between facility-based staff, community based health-workers and caretakers of children in improving followups for children who miss their appointments. 

We create profiles(database) on newborns either during their first shot or when they are born. We can then send SMS messages to caretakers reminding them of their baby's second and future shots. We can also send messages to community based health-workers to   followup on defaulters in-case of a missed appointment.

This is the idea from which RECALL was built. The system is programmed to deliver automated messages 4 days and 1 day prior to the appointment date as reminder SMS messages, then 1 followup message delivered to a community based health worker a day after a missed appointment. 

This approach adds on to the already existing approaches of indicating next appointment dates of child vaccination cards, maternal counselling, sticker reminders.

we target to improve the lives of infants (children age 6 weeks to 12 months) who would otherwise not  complete vaccination within 12 months and therefore suffer from vaccine preventable diseases, disabilities and deaths.

Our solution comes in handy to work alongside the existing interventions to improve compliance to the vaccination schedule and help combat vaccine preventable diseases.

Irene and George were born, grew up and went to school within the communities we are serving. After her training as a midwife, Irene volunteered in the local health center IV serving Bukedea district. She also studied and worked in Soroti and jinja regional referral hospitals.

In Bukedea like in many districts in north, west and central Uganda, diorrheal disease and measles out breaks are common, children don't complete vaccination.

Needs assessment was done and it showed a need to create a system that tracks defaulters from. Most mothers questioned noted that they forget to bring the babies or forgot the exact date of bringing back the baby for vaccination. 

Midwifes were doing a lot to educate mothers about the need to follow the schedule promptly but many mothers often forgot to come back, meaning that education alone was not adequate.

That is why Irene and the team came up with the idea of creating profiles and sending automated reminder SMS messages to caretakers prior to the day of the appointment, then follow-up reminder messages to community based health workers incase the caretaker missed the appointment. 

I need a partner to help us improve our solution.

we need to find a research team to help us in evaluating the impact of our intervention.

We need to connect with partners to help us to scale our intervention when our pilot is successful.

mobile Health is already implemented in Uganda. Our innovation increases recall rates of caregivers to bring children for timely vaccination using mobile technology interventions. The innovation delivers reminder messages through mobile phones, but also delivers additional messages/ reminders to community based health workers and facility based health-workers to inform them to follow-up on caretakers who miss out on their appointments to encourage caretakers to bring their babies but also to establish the reason they miss out so as to guide interventions and inform future decision making and planning. By doing this, we increase collaboration between health workers, and between health workers and caretakers hence improving timely vaccination completion rates.

Next year

- Increasing the number of children receiving DTP3 by 14th week and completing vaccination schedule by 12 months.

- Decrease preventable disease outbreaks

At five years

- Increase school hours

- decrease vaccine preventable deaths and disability

- Number of babies receiving DPT3 by age 14weeks

- Number of babies completing vaccination by age 12 months

Reminder messages are known to improve intervention uptake. in our program, Newborn babies are recruited and their profiles created during their first DTP shot, mobile phone contacts for the responsible caretakers are recorded; automatic reminder SMS messages are sent to the care takers 4 and 1 day  prior to the scheduled date of their vaccination. If the baby does not turn-up for vaccination, another reminder message is automatically sent to the community based health worker in their location and another to the healthcare provider at the health center. We believe that caretakers that receive reminder messages will remember to bring their babies to receive the shot on the scheduled date while for those that fail, followup by community health workers will encourage them to come by addressing their concerns. The health workers will also record the reasons they are not turning up. In the short-term, we expect the number of babies receiving and completing their vaccination within 12 months of life to increase and in the long term, we believe that this will translate to improvement in the health of this babies. Making sure that they don't suffer from frequent attacks by vaccine preventable infections. such babies grow up well and are able to spend much time in school. their parent are able to save money and take more time to work. This children exploit their fullest potential.

Mobile phone SMS Technology

Our team and programs intend to benefit every body irrespective of their race, tribe, place of origin, socioeconomic status, and background among others.

In our business model, while children will receive vaccines free of charge, the vaccination tracking and reminder system installation will require institutions to pay a little installation fee. These institutions include both public and private healthcare institutions that offer vaccination services.

The value we bring to our customers is the ability to keep track of vaccination for every child; keeping all records in one place; and improving trust among clients for services.

We look at sustaining our activities through a combination of methods; including: donations and grants, selling our services to private healthcare providers; entering contractual terms with the government, and NGOs and other revenue streams such as income generating projects.